Every effort should be made to avoid unnecessary use of seclusion and
restraint; therefore, staff should try to redirect and diffuse problem behavior
before employing the reactive strategy of seclusion and restraint.
(2) Seclusion and restraint as a reactive
strategy may be utilized only if certified staff persons are available in
sufficient number to ensure its safe implementation.
(3) Staff must continuously observe the
client during restraint procedures, monitor respiration rate, and determine
when release criteria have been met.
(4) Seclusion and restraint procedures
exceeding one hour require approval by an authorizing agent.
(5) Seclusion and restraint may not exceed
two hours without visual review and approval of the procedure by an authorizing
agent or the agent's on-site designee.
(6) Staff must obtain additional
authorization for use of seclusion and restraint for a behavioral episode
occurring more than fifteen minutes after termination of a prior procedure, and
document the additional use in the individual's record.
(7) Before initiating a seclusion or
restraint procedure, staff must inspect the environment and the individual in
order to ensure that any foreign objects that might present a hazard to the
individual's safety are removed.
(8) Any room in which the individual is held
must have sufficient lighting and ventilation to permit the individual to see
and breathe normally, and must have enough space to permit him or her to lie
(9) The door to
any room in which an individual is secluded without an attending staff person
must not be locked; however, the door can be held shut by a staff person using
a spring bolt, magnetic hold, or other mechanism that permits the individual in
seclusion to leave the room if the caregiver leaves the vicinity. Forensic
facilities may seek a waiver or variance from this requirement through Section
(10) An individual
mechanically restrained for more than one hour must be permitted an opportunity
for motion and exercise for at least ten minutes of each hour that the
individual is restrained.